HomeMy WebLinkAboutDriveway Permit ApplicationL {,#+ ,t.toe ¡",*{
i
.å!
a; ,"
!\:./
\
lì
1.,tNGarfield County Road and Bridge
0298 CR 3334
Rifle, CO 81650
PH: 970-625-8601 Fax: 970-625-8627
Email: roadandbridse@ sarfïeld-countv. com
Driveway Permit Application
Permit Fee: $75.00
1. Property owner: Tllô'q"atg I ]iEçs tcrq Y4d E¿R.
2. Mailing Address 4zq 0 f "íRJ 34 2
City, State, Zip:S¡lf ^ Cô 8¡bízJ
4
5
_______ T '
Phone No: SLo q b1 tLqtl Email (t r45@ e"c
6. Estimated Start Date:
Sub-contractor: N
1*TKrc
7. County Road No 34 n-
8. Nearest Intersection or Address: l28o Ctk), 312
9. Distance from Int. or Address 3oo ?1" :
10. Direction from Int. or Address:N
11. Side of Road:
12. Width of apron:30-foot
13. Culvert Required:Yes
14. Size of culvert required:12-inch
15. Length of Culvert:30-foot
16. Asphalt or concrete pad required:Yes
18-inch Other:_
40-foot 100-foot Other:
w
wSN
E
E
X.
X+o-root 1O0-foot Other:
No
Xrs-in"t
X*"
3O-foot wide X 10-foot long X 4 inches thick
4O-foot wide X 10-foot long X 4 inches thick
100-foot wide X 2O-foot long X 4 inches thick
17. Size of Pad
1 8. Gravel Recommended:No
**Gravel recommended so as to not track mud onto County Road.
( fonn o le-teÅ ând
' ofrf, {-tt#{:Å,\Xv.,
19. Length of gravel portion:40-foot 10O-foot
20. Trees of brush removed for visibility:Yes No
21. Distance and direction from driveway to be removed 3ö +ë qô ç+" *JorTL
X ro-roo,
22.Driveway must be no more than 3 % slope away from County Road.
23. Driveway must be constructed so that no drainage accesses the County Road.
24. Cefüfted traffrc control required:Yes
25. Work zone signage only required:Yes No
26. Stop sign required at entrance to County Road:Yes No
27. Inspection of driveway will be required upon completion and must be approved by Garfield
County Road and Bridge.
28. Person Requesting Permit:ôsL
29. Person approving Permit:
30. Date approved:4"s- ts
o
Payment Information
Ectrect f] Mastercard
Name of
Expiration Date: ___-J _V Code (last 3 or 4 numbers on back of card)
lSA
Billing Address:
Card Number:_l_l_l_ _l_l_J- _J-l-J-
Signature Required
Authorized Card Holder Signature